Saturday, December 24, 2016

We interrupt this vacation to welcome 2 new characters to the pages of Dr. Grumpy:

Garlic and Onion!

These are a pair of 7 year-old brother-sister litter mates who have never been separated. Their previous owner was unable to keep them and took them to a rescue, and now they've joined us. We only went to look at one, but taking them both was part of the deal, and how could we resist?

We have no real idea what they are, besides totally awesome dogs.

Mello is doing fine with them.

Remember, if you're looking for a great family friend this holiday, contact a rescue or humane society near you.

Friday, December 16, 2016

With the end of the year coming, we all know what that means: hanging out with friends, eating enormous amounts of food, and watching football. Those bowl games are right around the corner.

Of course, these are your friends coming over, so you want the best for game day: Beer, chips, and uh, I guess more beer.

But are your friends the discerning type who insist on high quality? The kind of connoisseurs who prefer Keystone beer to Budweiser? The epicurean master foodies who, after 4-5 cans of shitty reasonably priced brews will know the difference between Tostitos, Doritos, and the generic store-brand?

If so, then you need to serve them something truly special!

For only $56 you can get a delectable box of St. Erik's chips, made by the Swedish brewery.

Yeah, I said $56 bucks.

Featuring ingredients like truffle seaweed, Ammarnäs potatoes, Matsutake mushrooms, crown dill, and Leksand onions, these are the chips that are guaranteed to turn your beer-swilling gathering of buddies into an Edwardian soirée that will be talked about for years.

In case I didn't mention it, what you see above is exactly what you get: each $56 box contains only 5 chips, one in each flavor.

Yep. You read that correctly.

So this works out to $11.20 per chip. Plan accordingly as to how many boxes you'll need.

Friday, December 9, 2016

Life is full of tough decisions, especially when you have $85 to blow. What should you spend it on?

Like most people, you're probably thinking "if only there was a decent rock in a leather half-pouch I can get for only $85, but I can't find one."

Fortunately, Nordstrom has heard your cries, and is now selling exactly that: a solid rock, found somewhere in the Los Angeles area, and lovingly sewn into a leather case.

"You're shitting me, right?"

Order it here. The possibilities are endless! You (or the lucky recipient) can use this $85-rock-in-a-half-leather-case as a paperweight, doorstop, or artistic commentary on sado-masochism's relationship to classical philosophy's effects on the fabric of human relationships.

And, best of all, when someone asks "What did you get for Christmakuh?" You can say...

Wednesday, December 7, 2016

Keeping you up to date on the world around you, we at the Grumpy Neurological Emporium news division strive to bring you the most important stories.

Dateline: Florida.

A car with 4 days of parking tickets all over the windshield was found to have a dead body inside, slumped over the steering wheel. The unfortunate man had apparently died of natural causes shortly after getting into his vehicle.

The city of Fort Lauderdale has kindly agreed to dismiss the accumulated parking fines due to "extenuating circumstances."

Dateline: Oregon

Craig Buckner, after being arrested on drug charges (he'd fallen asleep while waiting outside a courtroom on other charges and was drug tested - I swear) was worried about his pet parrot's well-being. This is understandable, as the bird (imaginatively named "Bird") had been left outside the building in a tree.

Mr. Buckner was allowed to retrieve Bird the bird, but then Bird refused to be separated from him when they took the mugshot. After a few attempts officers decided to wing it, and snapped the picture anyway:

(Photo: Multnomah County Sheriff's Office via AP)

Dateline: Florida (again)

Unidentified burglars climbed over a backyard fence at night, hoping to break into a house. Due to them failing to scope out the area in advance, they landed on top of the owner's beehive, knocking it over.

The occupants were buzzing mad about beeing woken up, and chased away the evildoers.

Local hospitals have been asked to bee on the lookout for anyone coming in with an unusual number of stings.

Yes, now you can smell holiday-fresh EVERYWHERE (and I mean everywhere). But you better hurry, because this cosmetic necessity is only available until December 23.

BUT WAIT! THERE'S MORE! If having an invigoratingly holiday-smelling rectum isn't enough for you, you can now get mulled spice scented toilet bleach! Just in case Santa needs to use the john and puts his head below the rim to make sure you're on his nice list.

And (I SWEAR!) this toilet bleach is not only scented, but the site says it's safe for use by vegetarians and vegans.

Friday, December 2, 2016

And today I suspect a lot of seismic activity in the middle east is caused by him spinning rapidly in his grave. Because this is the man who, over roughly 1500 years, became Santa Claus in Western culture, appearing in shopping malls, used car lots, TV specials, Viagra commercials, movies, condom ads, and heaven knows what else.

I think Nikolaos would be pretty horrified by the whole spectacle of what he's become.

Even more horrifying, at least to me, are the Santa-themed business suits that are promoted as things you can wear to important meetings this time of year. I suppose this is a measure of job security. The only men likely to wear these outfits are the ones who know they can't be fired and those who want to be.

What am I talking about? Not the generic St. Nick suit that abounds on fat bearded guys working in department stores this time of year, but these hideous ensembles of jacket, slacks, and a tie:

"Hey, ladies, want to check out my sack?"

"The sneakers are for running, since this outfit is a chick magnet."

These are not, I must stress, pajamas. For PJ's they might be sort of cute. But no, someone designed and is selling them as standard business attire for this time of year.

So here's a perfect gift for the guy who... (let me get back to you on that).

Monday, November 28, 2016

As we near the end of another trip around the sun, it's again time for the annual...

Dr. Grumpy's Gift Guide!

I'm going to kick off this year with something truly meaningful. After all, in cultures around the world, motherhood is revered.

So what would be an ideal gift for your growing child to always remember mom by? Something meaningful, lasting, powerful...

I know! What could be more appropriate than jewelry made from your very own breast milk?

Featuring an array of bracelets, rings, and pendants, you can now remind your child, or yourself, or the guy who knocked you up, of all the sacrifices you made for them during your "nursing journey" (that's what the site calls breastfeeding, I swear).

Monday, November 21, 2016

Trapped by the dropping temperatures and unexpected snow this weekend, I got caught up on some medical reading. I thought I'd share some of it with you:

The driving abilities of patients with Alzheimer's Disease worsen as the disease progresses. In addition, people with Alzheimer's Disease were more likely to have trouble with driving and other complex tasks than age-matched controls without cognitive problems (Journal of Alzheimer's Disease, May 11, 2016).

Patients who suffered a massive stroke requiring neurosurgical decompression, and survived the whole thing, were more likely to be dependent on others for long-term care than those who didn't make it (New England Journal of Medicine, September 7, 2016).

Monday, November 14, 2016

I was a neurology resident, doing a rotation at a large county hospital. Like most county hospitals, it served a predominantly indigent population.

I was in my 2nd year of residency, 3 years out from medical school and in my late 20's.

She was the same age. I'd been consulted because she couldn't afford her epilepsy medication and had a seizure. She was also pregnant with her 4th child. So she was in the OB ward of the county hospital.

I had a job, an apartment a few miles away, a 4-year-old car in the parking lot, and a girlfriend (now Mrs. Grumpy).

She was homeless. None of her kids had the same fathers. She bounced between different shelters and whichever guy would take her and her kids in for a few days.

I'd showered that morning. She and her kids smelled awful, and obviously hadn't bathed recently.

I was in a generic shirt, tie, and pants from Target, with the required white coat. She and her kids were in tattered clothes from a donation center.

As I talked to her, scribbling her history down on my note pad, I suddenly realized I knew her.

10 years earlier we'd been in the same year in high school. We took PE, economics, typing, social studies, and chemistry together. We weren't close friends, but knew each other and said "hi" in the halls and local stores when we crossed paths. I suddenly had a vivid memory of her running to third base when I hit a single in a softball game.

I didn't mention it, and if she recognized me she didn't say so. I don't think she did. Her chart was huge, and I was just another in an endless stream of residents she dealt with on her frequent admissions. I restarted her seizure med and folic acid and she was discharged later that day. I went to another rotation the next week and never saw her again.

To this day I think of her. We came from the same upper-middle class backgrounds. We went to high school in American suburbia. Her parents were as successful in their area as were mine. Not wealthy, but comfortable, with expectations for their kids of college and a job and self-sufficiency.

I wondered how she got there. In 10 years we'd landed in very different lives. Had she made bad choices? Drugs? Alcohol? Had she just encountered terrible shit luck that all of us dread happening to us? A marriage gone bad? Domestic violence? A financial catastrophe beyond her control? I remembered seeing her and her parents posing for a picture at graduation. Did they know where she'd landed?

Sometimes, while trying to sleep, I think of her sitting there. I wonder if she's still on the streets. If she got her shit together and was able to move out of poverty. If she's even still alive. I'll probably never know.

Maybe she did something stupid, the kind of thing where all of us living in comfort can say "that would never happen to me, I'd never do something like that." Or maybe the circumstances were entirely beyond her control, the kind of financial clusterfuck nightmare that all of us dread destroying everything we have and work for.

I'll never know the answer. But the encounter always reminds me how much of life can be terrifying random chance, no matter how much we'd like to believe otherwise.

Monday, November 7, 2016

Mr. Sativa: "Hi, um, you saw me for headaches last year, and referred me to a headache specialist, and I kind of have an emergency, and I can't reach him."

Dr. Grumpy: "Okay... What's up?"

Mr. Sativa: "Well, that doctor suggested marijuana, and it works fine, but this morning my dog Mojo ate it all, and now he's really sleepy. I mean, he's breathing, but I can't wake him up. What should I do?"

Dr. Grumpy: "I'd call your vet. I don't treat dogs."

Mr. Sativa: "Oh, I hadn't thought of that."

Dr. Grumpy: "Okay, good luck and..."

Mr. Sativa: "With a stoned dog, um, should I play music or something?"

Wednesday, November 2, 2016

This is a common question I get from nurses before I leave their station. They understandably want to know what things are important to me in a given patient's care. Exam changes, abnormal test results, medication problems, etc. I'm fine with answering them, too. It's part of treating someone.

In the early 90's I was an intern, covering the cardiology and general medicine floors. One evening I was meeting with the other interns at a nurses station, getting the nightly check-out. This consisted of them each handing me a crumpled sheet of paper listing patient summaries for me to refer to if called. The lists were folded into a big wad and crammed into my white coat pocket. As I stood up to go see someone in ER, a nurse came over and asked what I wanted to be called on. I absently mumbled "any concerning changes" and stepped into an elevator.

The night ticked on. Several admissions, some calls to discuss labs and medications, the usual smorgasbord of pages. Somewhere after midnight there was a break in the action, and I went to the call room to try and sleep.

I dozed for maybe an hour before the nurse I'd spoken to earlier paged me.

Intern Grumpy: "This is Dr. Grumpy, returning a page."

Nurse Smokey: "Hi, I'm calling you about Mr. Gomer, in room 564. Are you familiar with him?"

Intern Grumpy: "Hang on..." I switched on the light, grabbed the wad of papers out of my pocket (I still had my coat on) and began flipping through them for room 564.

Nurse Smokey: "No worries, I'll wait."

Intern Grumpy: "Okay, I have him. It says he was admitted for a heart attack 2 days ago, and is scheduled for an angiogram tomorrow."

Nurse Smokey: "Yes, but he has other issues. He also has a history of lung cancer, for which he had surgery and radiation 2 years ago. It recently recurred, and he's now on chemotherapy. There's also him having COPD from being a smoker, and last month he was here for a pulmonary embolism and is on heparin. He needs a left knee replacement, but that's on hold for now due to his other medical issues. Do you need a list of his medications and allergies?"

Intern Grumpy: "No, I have that here... What's going on with him that you're calling?"

Nurse Smokey: "He's on fire."

Intern Grumpy: "WHAT?!!!"

Nurse Smokey: "He's on fire. He's on oxygen, and apparently his wife snuck in some cigarettes and matches and..."

The phone fell to the floor. I ran out of the call room into the stairwell and dropped down 2 flights to the 5th floor. As I flew past the station, Nurse Smokey was still on the phone with my empty call room, calmly saying "Hello? Dr. Grumpy? Can you hear me?"

In room 564 I found Mr. Gomer, miraculously uninjured except for some minor burns and missing eyebrows. He was almost completely covered in ashes and fire extinguisher foam (which a terrified student nurse was still randomly spraying at anything that moved, including me). Another nurse was pulling off the charred oxygen mask and melted tubing, while a respiratory tech made sure all the oxygen valves to the room were closed.

This was a good reason to call the doctor, if not the fire department. Skipping his past medical history, under the circumstances, might have been a good idea, too.

Wednesday, October 26, 2016

During election season it's easy to forget that their are other major news stories going on. So, as a public service, I'm taking a break from medical blogging to update you on what's going on in the world.

DATELINE: MAINE

Police in Portland were called to investigate a traffic disturbance, namely one caused by a man dressed as a tree standing in the middle of the road.

CBS WGME

Mr. Tree (my colleague Officer Cynical identified him as a Dendriticus idioticus) was asked to stop obstructing traffic. When he refused to do so he was placed under arrest.

An unidentified friend of his told officers the green fellow was "studying traffic patterns." I suppose it's possible he was trying not to be seen.

I highly recommend the original story here. It features a video of Mr. Tree being arrested while officers try to figure out which branches to put the cuffs on.

DATELINE: FLORIDA

A 28-year old man was leaving the Dancer's Royale strip club. Friends noticed he was intoxicated and asked him not to drive home, but he refused.

He got into his truck and was heading out of the lot when he somehow fell out of the driver's seat onto the road, and was run over by his own vehicle. He then fled the scene but his identity was quickly discovered as he'd left his driver's license behind.

The truck continued on its way down the road before crashing into a nearby home.

Monday, October 24, 2016

Time to hit the mailbag for more bullshit "artisanal" crap you guys have sent in.

Here's an offer for an artisanal vacation to Portland, Oregon. I have no idea how an entire trip can be artisanal. Is the plane rustic? (that doesn't sound safe, does it?). Is the rental car handcrafted? (yes, by giant sheet-steel-bending robots). You also get to "blend your own tea." Hell, I can do that with a large mug and a Keurig - at home.

Sara Lee, the McD's of grocery store bread, now has:

Not to be outdone, a mass-produced frozen pizza crust is now, what else,

But why stop at grocery store pizza crust? If you make over 10 million tortillas a year around the globe, doesn't that qualify them as artisanal? And what's "artisan style" anyway? What a person would make if they were made of metal and could manufacture 3000 tortillas an hour?

Then there's this. Although the word "artisanal" isn't in here, it's like they were using a thesaurus to find any other cheesy phrase in its place. And over what? FISH. How do you "handcraft" a fish?

After a hard day handcrafting fish, you're probably going to want to blow off steam at the gym. And where better to go than...

Regardless of what they're making, even artisans need to invest money for retirement. And where better to do that than in an artisanal mutual fund?

Wednesday, September 14, 2016

I get a fair number of emails from people asking me for advice on careers in medicine. I don't answer them often, because realistically I can't make those decisions for someone else. A career in this insane field, not to mention all its different branches, is a pretty personal choice.

A medical student, though, recently wrote and asked what one piece of advice I'd give anyone already in med school (besides "cut your losses and get the hell out"), so I thought about it.

Here it is:

Learn to tie shoes.

Yes, you read that correctly. That's my sage advice, for whatever it's worth, to all of you in training.

Now, I figure you already know how to tie your own shoes (although in the age of Velcro straps I could be wrong). What I'm talking about is tying someone elses shoes. This is a 180° reversed perspective of tying your own, and takes a little bit of getting used to, and not making them too tight.

During my 4th year of medical school I had a rotation where I was assigned to a family practice doc, just for his morning rounds at the hospital. I don't remember his name. He was in his mid-50's, and was always neatly dressed with a tan blazer. I'd meet him outside the doctor's lounge every morning and we'd see his hospital patients.

What always impressed me is how he knew his patients. Not just their medical stuff, but he'd often make comments like "she bakes the best sweet potato pie" or "he paints great landscapes." And his patients clearly adored him, too.

Anyway, the time we rounded was usually when breakfast was being brought around. Most docs I'd met would just ignore it, and have the food set aside until they were done talking to them.

But not this guy. He'd take the trays and help sit the patient up to have them. He'd ask what they liked in their coffee (though usually he already knew!). He'd open those little cardboard milk cartons (they can be tricky) and pour it in cups or on cereal. He peeled and cut up bananas for them.

And, if we happened to go in while they were getting ready to go home, he'd help them tie their shoes.

Although some may find this silly, I found it was a pretty important lesson. Letting your patients know you care about them goes beyond looking in ears and reviewing labs. It wasn't an act, this guy obviously just wanted to help them.

I typically don't round during meals, but I do tie shoes. Checking feet for atrophy, sensation, and reflexes are a big part of being a neurologist, so you end up with barefoot patients sitting on your exam table.

Younger people generally don't want help, but older people or those with physical limitations appreciate it. Helping them put on socks and tie their shoes may not seem like a lot... But it is. It's letting someone know you care about them, no matter how grody their toenails are.

Pro tip: always keep a shoe-horn handy.

No matter how far you go in medicine and life, never think that you're above helping another person put their shoes and socks on. You aren’t. And someday you may be in their position.

Friday, September 9, 2016

“Hi, I saw Dr. Grumpy about 10 years ago for something or another.
Anyway, my wife may have had a stroke, or migraine, one of those things, this morning. I’d like him to
order an MRI on her for today. We’re flying out tonight to Europe, so
need it before then."

Wednesday, August 24, 2016

It was a cheap chicken pot pie. The frozen kind, that your mom makes you eat when you're growing up.

I was a college student, living in a small condo near BSU with 3 other guys, in the mid-1980's

The place was old, and (like most college-based condos) not in the best repair.

One night, I made the fateful decision to have a chicken pot pie for dinner (this is college, man, you eat what you can afford).

I put it in the oven (a real oven, we didn't have a microwave), turned it on, set the timer, and went back to my room to read. As I left the kitchen I heard a loud mechanical "clunk," though didn't think anything of it at the time. The dump was full of weird noises.

When I wandered back 30 minutes later, I discovered the oven had somehow activated its self-cleaning mode - meaning it locks the oven door and heats itself up to something on the Kelvin scale to incinerate anything inside. Including my dinner.

The whole condo at this point began smelling like a chicken pot pie. I turned off the oven, only to discover that it had broken. Even with the cleaning cycle stopped. The door was locked and couldn't be opened.

I walked over to McD's that night for dinner.

The chicken pie was now a fixture of the condo. There was no way to get the oven door open without tearing it apart. The landlord didn't really care about fixing it since the place was falling apart, and the 3 of us didn't have the money to fix it ourselves. So we left it there.

As the semester progressed the kitchen would occasionally develop a weird smell from the culture medium residing in the oven. When this happened (every few weeks) we'd turn the oven on for a while to bake the culture into oblivion for another month or so. We'd turn it off again when it began to smell like chicken & mold pot pie. For all I know the oven had become a primordial soup experiment, and some new life form was evolving.

When I moved out 6 months later the pie was still in there. For all I know it still is.

So, if you're a college student living in a run-down condo with a locked oven that smells like a chicken pot pie when turned on... I'm sorry.

Monday, August 15, 2016

Another exciting school year will be starting soon, and somehow I got sucked into becoming a band booster. This thrilling job involves me handling questions from other parents about band, upcoming band camp, musical instrument rentals, over-the-counter medications, do you know a good plumber, next week's weather forecast, and why are you calling me because the judge said it's my ex who has to pay for this stuff.

In a week of calls, this one was my favorite:

My iPhone rings.

Nurse Grumpy: "Hello, this is band booster Grumpy."

Mrs. Clueless: "I just found out my daughter, Marsha, has to bring her musical instrument to band camp?"

Friday, August 5, 2016

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

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Note: I do not answer medical questions. If you are having a medical issue, see your own doctor. For all you know I'm really a Mongolian yak herder and have no medical training at all except in issues regarding the care and feeding of Mongolian yaks.